Provider Demographics
NPI:1912607920
Name:KILLIAN, CHRISTY RENAE (RBT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:RENAE
Last Name:KILLIAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:245 JIM TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-5562
Mailing Address - Country:US
Mailing Address - Phone:931-252-9060
Mailing Address - Fax:
Practice Address - Street 1:170 BLUE DEVIL LN
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-6020
Practice Address - Country:US
Practice Address - Phone:931-268-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-219028106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician